Medical Billing Services in
Massachusetts
We support clinics, practices and outpatient centers across MA with accurate coding, payer-aligned
workflows and compliance built around MassHealth and the state’s major commercial insurers.
HIPAA Compliant
MassHealth Ready
98% Clean Claim Rate
The Unique Billing Challenges
Massachusetts Practices Face
Alabama’s healthcare system includes large rural populations, substantial Medicaid utilization
and payer-specific rules that vary across regions. Providers need precise documentation,
strict PA workflows and payer-aligned submissions for consistent reimbursement.
High denials from BCBS MA and Tufts modifier rules
PA delays for imaging, therapies and specialty care
Medicare Advantage shifts affecting reimbursement timelines
MassHealth documentation and visit frequency requirements
Eligibility variations across Health Connector and commercial plans
Different payer behavior across Boston metro vs regional counties
We keep your billing accurate, compliant and predictable statewide.
Complete Billing Support Built
for Massachusetts Clinics
Medical
Billing
Clean claims, faster reimbursements, and billing accuracy.
Medical
Coding
Accurate ICD-10, CPT, and HCPCS coding with specialty-trained coders.
Billing
Audit
Identify hidden revenue leaks instantly
A/R
Follow-Up
Aggressive follow-up on 30/60/90+ day claims to reduce aging AR.
Credentialing &
Enrollment
Fast payer enrollments, CAQH updates, and NPI support.
State Licensing
Support
Hassle-free provider licensing and renewals across multiple states.
Denial
Management
Fix root causes, recover revenue, and prevent future denials.
Billing Platforms and Clearinghouses
We Work With in Massachusetts
We work smoothly inside your existing EMR, PMS, or
clearinghouse, no disruption, no retraining.
Common in Massachusetts
If your system isn’t listed, we likely support it.
Specialties We Serve
Across Massachusetts
Massachusetts practices operate in a highly specialized environment
with high patient volume and strict payer rules. We support
Massachusetts Focused Billing
Intelligence
Massachusetts billing requires payer-aligned workflows, strong documentation
accuracy and experience with MassHealth and regional commercial plans
Experienced with BCBS MA, MassHealth, Tufts
and Harvard Pilgrim
Accurate coding for outpatient and high-
volume specialties
Dedicated billing support tailored to
Massachusetts practices
Eligibility verification for ConnectorCare and
plan variations
Faster resolution for Medicare Advantage claim
issues
Precise denial analysis to prevent repeat errors
Your practice receives predictable, stable monthly revenue.
MassHealth and Medicare
Billing Rules
MassHealth Billing Requirements
Prior authorization is required for many imaging and specialty procedures
Behavioral health and therapy services often have session limits
Documentation must align with CPT codes and medical necessity
Timely filing varies by program and plan structure
Limited out-of-network billing options
Massachusetts Medicare Rules
Clear guidance for MassHealth filing, authorization,
documentation and specialty billing requirements.
Processed by Palmetto GBA JH
Common issues include
Modifier 25
usage
Bundling or
unbundling
errors
NCCI procedure
conflicts
We fix these before submission.
Common Claim Denials in
Massachusetts
Denial Code
CO-197
CO-16
CO-109
PR-1
CO-45
CO-50
Issue
Authorization missing
Missing information
Not covered
Deductible
Fee schedule
Medical necessity
MA Reason
Tufts and BCBS MA require a strict PA
Frequent in MassHealth claims
ConnectorCare plan limits vary
Medicare and MA Advantage
MA commercial payer limits
Behavioral health and therapy
Fix
Submit PA with clinical notes
Correct demographics or eligibility
Verify coverage rules
Confirm benefits and collect
Adjust and rebill
Add detailed documentation
Fixing Massachusetts Denials
We resolve errors quickly, prepare appeals and track local payer trends to prevent recurring denials.
Major Massachusetts
Payers We Bill For
Payer Name
Blue Cross Blue Shield of MC
MassHealth
Harvard Pilgrim Health Care
Tufts Health Plan
Fallon Health
Mass General Brigham Health Plan
UnitedHealthcare MA
Aetna MA
Cigna MA
Medicare Part B (NGS)
Type
Commercial
Medicare
Commercial
Commercial
Commercial
Commercial
Commercial or Medicare
Commercial
Commercial
Medicare
Notes
Modifier sensitive; strict edits
Documentation and PA required
Bundling issues common
Prior auth heavy
Behavioral health strict
New plan complexities
Coding edits frequent
Precert needed
Diagnosis linking issues
NCCI conflicts
Cities We Serve in
Massachusetts
Boston
Worcester
Springfield
MobCambridgeile
Lowell
Brockton
Quincy
Lynn
New Bedford
Counties We Serve in
Massachusetts
Middlesex
Worcester
Suffolk
Essex
Norfolk
Bristol
Plymouth
Hampden
Barnstable
Hampshire
Berkshire
Franklin
Performance Highlights
Our billing engine is built for speed, accuracy and financial reliability,
explicitly tailored for Massachusetts payer workflows
98%+ Clean
Claim Rate
30 to 50
percent denial
reduction
Specialty-aligned
CPT and ICD
accuracy
HIPAA-compliant
billing practices
Real-time revenue
cycle reporting
Our Billing Workflow for
Massachusetts Clinics
01
Eligibility Verification
& Medicaid Checks
02
Coding & Charge
Entry
03
Clean Claim
Review
04
Submission to
Clearinghouse
05
A/R Follow-Up
06
Denial
Management
07
Monthly Revenue
Reports
Ready to strengthen your
Massachusetts practice revenue
Let our billing team optimize your claims, improve coding accuracy and reduce denials
What Massachusetts Providers
Say About Us
Dr. Emily S.
Dermatology
“They understand specialty coding better than most in-house teams.”
Laura P.
Urgent Care
“We recovered thousands in lost AR. Reporting is clean, simple, and accurate.”
Dr. Michael R.
Cardiology
“Collections improved within 60 days. Their denial management is the best we’ve seen.”
Dr. Sofia M
Behavioral Health
“Behavioral health denials dropped massively. Their team knows payer rules inside out.”
Dr. Emily S.,
Dermatology
“They understand specialty-specific coding better than most in-house coders.”
Laura P.,
Urgent Care
“We recovered thousands in lost A/R within weeks. Reporting is clean and accurate.”
Dr. Michael R
Cardiology
“Collections increased in the first month. Their denial correction is faster than any team we’ve used.”
FAQ for Massachusetts Providers
Yes, we support solo providers, clinics, urgent care and multi-location groups.
Yes, including MassHealth, BCBS MA, Tufts, Harvard Pilgrim and Fallon Health.
Yes, including primary care, behavioral health, therapy and specialty billing.
Most MA providers see improvement within 60 to 90 days.
Epic, Cerner, Athena, eClinicalWorks, DrChrono, AdvancedMD and more.
Yes, with structured follow-up cycles based on payer timelines.
More than 20, including cardiology, behavioral health and urgent care.
Yes for MassHealth, BCBS MA, Tufts and all major commercial plans.
Credentialed providers go live in 3 to 5 days.
Address
4309 Schubert, Colleyville Texas, TX 76034
Phone Number
(737) 787 2147
Business Hours
Monday – Friday: 08.00 – 17.00 Saturday: 09.00 – 12.00
